Individual
RICHARD XAVIER BRENNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12700 SOUTHFORK RD, STE 230, SAINT LOUIS, MO 63128-3201
(314) 849-3711
(314) 849-0235
Mailing address
12700 SOUTHFORK RD, STE 230, SAINT LOUIS, MO 63128-3201
(314) 849-3711
(314) 849-0235
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
336-069221
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
MDR6H23
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156440092
MEDICARE PTAN #
MO
05
—
206853004
—
MO
Enumeration date
06/05/2006
Last updated
03/14/2017
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